The full content of Annals is available to subscribers

The systemic capillary leak syndrome (SCLS) can be a dramatic, perplexing, and terrifying disease to treat, particularly in its initial presentation. We have treated a patient with recurrent SCLS and have consulted by telephone on another patient. We thank Druey and Greipp for raising awareness of this rare syndrome and would like to complement their excellent review (1) with our anecdotal experience and 3 comments.

First, we agree with their observation that SCLS is distinct from sepsis in its weak response to vasopressors and its associated polycythemia and severe hypoalbuminemia, but these findings are more obvious in retrospect. The clinical features of hypotension, tachycardia, and leukocytosis should trigger a work-up for sepsis and empirical broad-spectrum antibiotic therapy in most cases of new SCLS.